Navigating Medicare and Open Enrollment: Actionable Advice for Direct Primary Care Practices

This weekend Maryal spoke at the Robert Wood Johnson Health Policy Fellows event in Washington, D.C. about the growing impact of the Direct Primary Care clinic model in combating physician burnout and promoting sustainable, relationship-based healthcare, so the next main episode will drop next Sunday. 

This episode continues to spotlight the latest issue of “The Toolkit,” a free DPC magazine curated by My DPC Story, designed to support clinics through open enrollment season. The Toolkit offers practical tools, customizable patient resources, and actionable checklists to help physicians and clinics navigate insurance changes and confidently discuss Medicare and healthcare benefits with their patients without feeling like insurance brokers. Listeners will find features on how DPC can help avoid pharmacy surprises and cost spikes, and detailed policy updates like the big win enabling HSA dollars for DPC memberships.

Maryal also shines a light on inspiring DPC leaders who are innovating at the practice level like Dr. Emily Holt and shares information on upcoming events like the DPC Coalition’s webinar on HSAs and the RiseUp Physician Summit for DPC physicians exploring side gigs and direct contracting HAPPENING THIS Oct 23-26th! If you’re a physician looking for meaningful ways to deliver or maintain your delivery of relationship-based care, prevent burnout, and thrive during open enrollment, this episode—and The Toolkit magazine—are essential resources. Download the free issue at mydpcstory.com/magazine and stay ahead in your DPC care journey!

Save $100 on your Hint Summit 2026 ticket through October 31st and join the chorus of direct care leaders shaping tomorrow.

Transcript

Maryal concepcion: 0:43

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the my DPC story podcast, where each week. You will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle conception family physician, DPC, owner, and former fee for Service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct Primary care.

1:31

Hey, my DPC story listeners, Marielle here. I wanted to share something that happened that was super special this week. I had the incredible honor of being invited to speak on a panel at the Robert Wood Johnson Health Policy Fellows Foundation event in Washington DC and that's where I'm at recording here. It's so truly humbling to be part of this important national conversation about healthcare policy alongside amazing women. And you can read more about that on LinkedIn and our substack. Um, but to be alongside other women leaders who are making change happen because they're sharing their stories similar to. The physicians who have shared on my DPC story and because of me being in Washington DC here on No King's Day on October 18th, um, I will be dropping our next main episode. Next week. So I don't wanna leave you hanging in the meantime, and I wanna make sure that you are aware if you're not, please download the free third issue of our magazine that my DPC story puts out, specifically focused on direct to primary care called the Toolkit. It's a free magazine again, focused on open enrollment and helping your DPC clinic prepare for this open enrollment season that started three days ago. So inside the magazine you'll find an open enrollment feature that starts with a simple truth that every fall coverage resets while life keeps moving. And that is very much true even though the government has shut down. Formularies are shuffling, networks are tightening and employers rebid benefits. And by January 1st, patients want one thing, confidence that nothing important fell through the cracks. And we know very well what that feels like when we talk with our patients about their healthcare benefits from even before we open our clinics to five years plus. The issue walks through how DPC can be a steady hand and how specifically our relationship based primary care can help prevent pharmacy surprises and cost spikes before they even happen. You'll also get practical tools like easy to use checklists, and scripts you can use in your visits, emails, and texts. So this is a. Specific issue to help you have confident conversations about Medicare plan changes and how DBC fits into a patient's overall healthcare picture without. You or anybody else in your clinic turning into an insurance broker, there is a deep dive article on how to prepare for your DPC for January 1st, 2026, including what dates to mark on your calendar, examples of talk tracks with patients, and what to clarify about DPC versus Medicare and Medicare Advantage coverage. And we have a link in our magazine to the Open Enrollment Survival kit that I put out earlier this week as well, which includes copy and paste templates for texts, emails, social media, and a customizable one pager in Canva that you can brand for your own clinic and print out or use on your FAQs or presentations that you're doing around your community. There's also an article called DBC at the Crossroads, why the time to act is now breaking down How the big, beautiful bill, quote unquote, and specifically HR one within the big beautiful Bill finally allows HSA dollars to pay for DBC memberships. it's a huge policy win that has been over a decade in the making. And you can read more about it. In that same spirit, there's a call to action to join the upcoming DPC Coalition webinar on November 6th at 1:30 PM Pacific. It's all about DPC HSAs and the future of healthcare policy. So you can register for the coalition meeting@dpcare.org. That's dpc.org. The issue also features inspiring DPC leaders like Dr. Emily Holt in New Orleans, who's redefining healthcare in a world where FQHC models are under pressure. And Christie Snodgrass, many of you might know her, she's a DPC patient as well as a nurse and fierce patient advocate who's helping people fight medical debt and access fair pricing for things like imaging and prescriptions. There's also, it just keeps going articles on DPC and Medicare to opt in or opt out. What that means for your ability to do side gigs or direct contracting. And an article about health shares for the self-employed, exploring alternatives to traditional insurance during open enrollment, also protecting the future of DPC from becoming another corporate venture capital driven model. a powerful piece by. Humanistic benefits advisor, and a good friend Callie Ortega. there's also examples from DPC doctors directly about what they do for their own healthcare plans, for their families and finally, don't miss the call outs for the upcoming events that are noted in the magazine, like the RiseUP Summit, a physician led virtual event covering dpc, locums and direct contracting. And that's actually coming up later this week. So you can sign up for that@flexmedstaff.com slash RiseUP. Definitely check out that summit lineup And if you're practicing DPC in California or planning on it, early tickets for the 2026 California DPC summit are open for a reservation right now. The tickets have not gone live, but they're, the tickets are able to be reserved and we've had. Over a third of our tickets already reserved, so it's gonna be in Newport Beach in June of next year, so definitely get on that soon. Cali dpc.com is where you're gonna go to reserve one of those tickets so while I'm in DC this week representing DPC at the policy level, I hope you take some time to read through this incredible issue of the toolkit. It is again, filled with resources to help your clinic thrive through open enrollment and beyond. You can download it for free at my dpc story.com/magazine. So until next week, take care, stay inspired, and keep doing the good work. I'm gonna go to sleep and wake up. Rested and excited to be refreshed tomorrow and keep fighting the good fight.

Maryal concepcion: 7:15

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.